A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease

BACKGROUND

Coughing may be produced by a number of different disorders in distinct anatomic sites. Chronic cough causes major functional limitation in a considerable patient population and requires careful evaluation.

METHODS

Seventy-eight nonsmoking patients of both genders who complained of cough for > or =3 weeks and had normal findings on plain chest radiographs were studied prospectively. Their histories were obtained, and physical examinations were performed. The diagnostic workup included pulmonary function tests, CT of the paranasal sinuses and chest, carbachol provocation test, fiberoptic rhinoscopy, fiberoptic bronchoscopy, and 24-h esophageal pH monitoring. The final diagnosis depended on clinical, radiologic, and laboratory findings; a successful response to therapy was required for confirmation.

RESULTS

The causes of chronic cough were determined in all patients. Coughing was due to a single cause in 30 patients (38.5%) and multiple causes in 48 patients (61.5%). The five most important causative factors were asthma (46 patients; 58.9%), postnasal drip syndrome (PNDS; 45 patients; 57.6%), gastroesophageal reflux disease (GERD; 32 patients; 41.1%), bronchiectasis (14 patients; 17.9%), and tracheobronchial collapse (11 patients; 14.1%).

INTERPRETATION

Asthma, PNDS, and GERD, alone or in combination, were responsible for 93.6% of the cases of chronic cough. The presence of these three conditions was so frequent that the expression "pathogenic triad of chronic cough" should be acknowledged in specialized literature. It is essential to consider pulmonary and extrapulmonary causes in order to prescribe a successful specific therapy for chronic cough.

Downgrading, downsizing, degazettement, and reclassification of protected areas in Brazil

Protected areas (PAs) are key elements for biodiversity conservation and ecosystem services. Brazil has the largest PA system in the world, covering approximately 220 million ha. This system expanded rapidly in the mid-1990s to the mid-2000s. Recent events in Brazil, however, have led to an increase in PA downgrading, downsizing, and degazettement (PADDD). Does this reflect a shift in the country's PA policy? We analyzed the occurrence, frequency, magnitude, type, spatial distribution, and causes of changes in PA boundaries and categories in Brazil. We identified 93 PADDD events from 1981 to 2012. Such events increased in frequency since 2008 and were ascribed primarily to generation and transmission of electricity in Amazonia. In Brazilian parks and reserves, 7.3 million ha were affected by PADDD events, and of these, 5.2 million ha were affected by downsizing or degazetting. Moreover, projects being considered by the Federal Congress may degazette 2.1 million ha of PA in Amazonia alone. Relaxing the protection status of existing PAs is proving to be politically easy in Brazil, and the recent increase in frequency and extension of PADDD reflects a change in governmental policy. By taking advantage of chronic deficiencies in financial and personnel resources and surveillance, disputes over land tenure, and the slowness of the Brazilian justice, government agencies have been implementing PADDD without consultation of civil society. If parks and reserves are to maintain their integrity, there will need to be investments in Brazilian PAs and a better understanding of the benefits PAs provide.

Long term prognosis of acute pulmonary embolism

BACKGROUND

Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of patients hospitalized with acute PE and compare survivalof patients with idiopathic and secondary PE.

MATERIALS AND METHODS

We retrospectively analysed a cohort of hospitalized patients with acute PE between 2006 and 2013.

EXCLUSION CRITERIA

<18 years, venous embolism of non-pulmonary veins, chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image confirmation. Only patients with a first PE episode were included. End-point: all-cause mortality. Patients were compared according to PE aetiology: idiopathic, secondary to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression analysis was used to study the prognostic impact of PE aetiology.

RESULTS

We studied 872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE attributed to a non-neoplastic condition.

CONCLUSIONS

Patients with idiopathic acute PE have an almost 50% higher death risk in a median 2-year follow-up period than those with acute PE secondary to a condition other than neoplasia.

[Porcelain veneers]

Through a clinical situation is shown the technique for the placement of a porcelain bonded veneer. Its significance with in the Esthetic Restorative Dentistry, advantages and disadvantages are emphasised. Together with the clinical procethe laboratorial steps are also shown. It was concluded that the bonded porcelain veneers are new options for a Restorative Dentistry more conservative with excellent esthetic results.

Self-Supported Biopolymeric Films Based on Onion Bulb (Allium cepa L.): Gamma-Radiation Effects in Sterilizing Doses

Sterilization is a fundamental step to eliminate microorganisms prior to the application of products, especially in the food and medical industries. γ-irradiation is one of the most recommended and effective methods used for sterilization, but its effect on the properties and performance of bio-based polymers is negligible. This work is aimed at evaluating the influence of γ-radiation at doses of 5, 10, 15, 25, 30, and 40 kGy on the morphology, properties, and performance of bioplastic produced from onion bulb (Allium cepa L.), using two hydrothermal synthesis procedures. These procedures differ in whether the product is washed or not after bioplastic synthesis, and are referred to as the unwashed hydrothermally treated pulp (HTP) and washed hydrothermally treated pulp (W-HTP). The morphological analysis indicated that the film surfaces became progressively rougher and more irregular for doses above 25 kGy, which increases their hydrophobicity, especially for the W-HTP samples. In addition, the FTIR and XRD results indicated that irradiation changed the structural and chemical groups of the samples. There was an increase in the crystallinity index and a predominance of the interaction of radiation with the hydroxyl groups-more susceptible to the oxidative effect-besides the cleavage of chemical bonds depending on the γ-radiation dose. The presence of soluble carbohydrates influenced the mechanical behavior of the samples, in which HTP is more ductile than W-HTP, but γ-radiation did not cause a change in mechanical properties proportionally to the dose. For W-HTP, films there was no mutagenicity or cytotoxicity-even after γ-irradiation at higher doses. In conclusion, the properties of onion-based films varied significantly with the γ-radiation dose. The films were also affected differently by radiation, depending on their chemical composition and the change induced by washing, which influences their use in food packaging or biomedical devices.

A phthalimide-triazole derivative obtained by click chemistry exhibits trypanocidal activity, induces autophagy and ameliorates Trypanosoma cruzi infection

Chagas disease (CD), caused by Trypanosoma cruzi, remains a leading cause of cardiomyopathy and heart failure in Latin America. Since the 1970s, benznidazole (BNZ) and nifurtimox (NFX) have been the only chemotherapeutic agents used to treat CD. However, their toxicity and low effectiveness in the chronic phase of the disease, make the development of more efficient chemotherapeutics imperative. Here, we investigated the effects of 1,2,3-triazole hybrids, synthesized via click chemistry, containing either phthalimide (FT1, FT2, FT3, FT4) or naphthoquinone (NT1) moieties on T. cruzi and their cytotoxicity on mammalian cells. NT1 and FT1 were the most effective against intracellular parasite with an IC50 = 31.1 and 189.2 µM, respectively. FT1-FT4 showed low cytotoxicity to mammalian cells (CC50 > 754 µM), while NT1 exhibited moderate toxicity (CC50 ≥ 96.1 µM). FT1 demonstrated the highest selectivity towards trypomastigotes and amastigotes with selectivity indexes (SeI) of 6.9 and 6.7, respectively. Ultrastructural analysis of trypomastigotes treated with FT1 revealed mitochondrial alterations, lipid accumulation and Golgi complex disorganization. FT1 also decreased the mitochondrial membrane potential, increased mitochondrial reactive oxygen species (ROS) production, and induced late apoptosis in trypomastigotes. In infected cardiac cells, FT1 treatment led to degradation of amastigotes and Golgi disruption. An increase in autophagosomes in treated host cells and their interaction with intracellular parasites suggest that FT1-induced host cell autophagy may play a role in mitigating the infection and protecting cardiac cells from its deleterious effects.